Tourniquet cuffs are used by orthopedists, anesthesiologists and other medical practitioners to stop the flow of blood through an artery by compression, and are typically placed proximally on an upper or lower extremity such as the upper arm or thigh, and occasionally in a more distal position such as on the calf. Inflatable tourniquet cuffs are commonly used in the medical field, and include bladders that are inflated by compressed air, producing enough compression to occlude the arterial flow. For an orthopedist or other surgeon who does extremity surgery, this achieves an avascular, or “non-bleeding,” dry surgical field. By stopping the flow of blood into the extremity, surgery can be performed in that extremity distal to the tourniquet cuff without bleeding. With the artery occluded, no blood flows into the surgical field and the surgeon can perform surgery in what is temporarily a bloodless surgical field.
To completely stop the flow of blood, a tourniquet cuff should be applied as high as possible into the axilla or “armpit” in an upper extremity, or into the groin adjacent to the inguinal ligament located at the crease between the lower abdomen and the anterior, or front part of the top of the thigh. Such placement occludes the artery before it begins to divide into its branches, and provides a surgeon with a large operative field for elbow and knee surgery. A large area is needed in order to prep the skin adequately and to drape the area properly so that during surgery, if an incision needs to be extended, the surgeon does not need to cut through drapes to do so.
Tourniquet cuffs in the form of blood pressure cuffs, are also used by anesthesiologists to monitor blood pressure during surgical procedures, by nurses in intensive care units, by medical personnel in transitional care units, among others. A blood pressure cuff is often applied and left on for an extended time period, i.e., several days. The cuff is applied as high as possible on the upper extremity in order to more effectively occlude the artery before it branches and obtain a more accurate blood pressure measurement.
In use during a surgical procedure, a tourniquet cuff is applied with continuous pressure for an extended period of time. In the use of a blood pressure cuff during a surgical procedure or in an intensive care or cardiac care unit, the cuff is automatically and repeatedly inflated and deflated at about one to two minute intervals to monitor blood pressure, and can be left on for several days. This adds up to numerous compressions of the skin during a procedure or treatment period.
Tourniquet cuffs are commercially available and typically 2 to 6 inches wide for single bladder tourniquets and about 8 to 9 inches wide for double bladder tourniquets (“Bier blocks”). A blood pressure cuff about 4 inches wide is used most frequently by anesthesiologists. For an average size patient, a 4-inch wide tourniquet is used for upper extremity surgery, while a 4- to 6-inch wide tourniquet is typically applied to the thigh for surgeries on the lower extremities.
Tourniquet cuffs are generally supplied without padding, and some surgeons and anesthesiologists use a tourniquet cuff without padding underneath. However, this can result in injury to the skin caused by prolonged or intermittent pinching while the surgery is performed or when the blood pressure tourniquet cuff is inflated/deflated to monitor blood pressure. To avoid skin irritation and damage to the outer layers of the skin by the repeated compression, a soft padding material is often applied around the extremity under the cuff.
The use of tourniquet cuffs is problematic. The diameter or circumference of the upper arm and thigh decreases from the proximal end (i.e., shoulder, hip) to the distal end (i.e., elbow, knee). In most people, the upper arm and thigh are conically shaped like an ice cream cone, being wider at the top and narrowing toward the elbow or knee. This presents problems in maintaining a tourniquet cuff in a stationary position on the upper part of the arm or the upper part of the thigh. Oftentimes, a tourniquet cuff, with or without padding, tends to slip distally down the extremity during a procedure. This situation becomes more problematic as the weight of the person increases and the distal part of the extremity is proportionately smaller than the proximal part. In addition, a heavier patient tends to have looser skin and subcutaneous tissues, requiring a higher amount of compression to occlude the artery for surgery or to obtain blood pressure.
Slippage of a blood pressure cuff along a limb causes particular problems for anesthesiologists and surgeons. For surgical procedures, the tourniquet cuff is applied to the upper arm and inflated, blood pressure is recorded, and the cuff is then deflated. As this is repeated over an extended time during the procedure, the cuff slips distally and a different part of the extremity becomes compressed. This change in the location where the blood pressure measurements are taken can result in inaccurate readings.
There have also been numerous complaints about tourniquet slippage down the arm or thigh and causing problems with proper occlusion of the artery during surgical procedures. For a surgical operation performed on an elbow, knee, forearm, hand, calf or foot, as the tourniquet slips distally, compression decreases and compromises the surgical field with bleeding. In addition, the distal edge of the tourniquet is not sterile, and as the edge enters the surgical field, the potential for post-operative infection increases. There have also been problems with the tourniquet or cuff slipping off the underlying padding material onto the skin, resulting in blisters where the skin had been pinched.
One padding device, the Tournicuff® pressure cuff padding, described in U.S. Pat. No. 7,326,227 and U.S. Pat. No. 6,537,298 (Dedo), is designed as a wrap with an anti-slip surface against the skin to provide traction and reduce or preclude slippage of a tourniquet cuff during use. Although this device is effective as both padding and a holding device, it would be desirable to provide an alternate device for use in holding a tourniquet cuff in place on a limb during use.